The North American Society Leadership drafted a consensus report synthesizing recommendations by cardiovascular societies dealing with the safe reinstatement of elective procedures and tests, halted during the first wave of the novel coronavirus disease 2019 (COVID-19) pandemic. This report was published in Annals of Thoracic Surgery.

Due to the ongoing COVID-19 pandemic, cardiovascular care services, including routine medical care, have been restricted, in line with official physical distancing recommendations. In addition, the reduction in diagnostic testing for cardiovascular conditions during this period is likely to lead to undiagnosed cases and delayed treatment.

The Society recommends, in accordance with public health officials, cardiovascular care be safely and gradually reintroduced during the pandemic in 3 levels:

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Level 2: Select services to be reintroduced, eg, invasive procedures in high-risk non-ST-elevation myocardial infarction; primary percutaneous coronary intervention for most patients; transcatheter aortic valve replacement for severe symptomatic aortic stenosis; inpatients waiting for coronary or valve surgery.

Level 1: Most services to be reintroduced, with the deferral of stable cases.

Level 0: All services to be reintroduced, while maintaining diagnostic testing for COVID-19.

It is recommended that cardiovascular teams maintain communication with public health officials regarding the tracking of the pandemic and the status of cardiovascular patients. Such channels will allow for the safe reintroduction of cardiovascular services. In some regions, an uptick in the number of COVID-19 cases has been observed following the lifting of social restrictions. In such instances, the suspension of elective procedures should be reinstated promptly.

In addition, the protection of patients and health care workers is essential during the reintroduction of cardiovascular services, and hospital leadership should collaborate with local and regional public health officials to ensure that sufficient personal protective equipment and COVID-19 diagnostic tests are available for health care workers, both during the reopening of services, and in the eventuality of a second peak of the pandemic.

Physical distancing in health care settings can be achieved with strategies that include virtual pre-procedural clinics and virtual consenting for procedures and testing. In additions, patients should be routinely screened for COVID-19 prior to cardiovascular procedure or testing, using nasopharyngeal swabs/saliva or rapid antibody tests.

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“Leaders from the North American cardiovascular societies acknowledge that the recommendations in this guidance document are based predominantly on expert opinion. This reflects the global challenge of managing a new and rapidly evolving pandemic where evidence is limited,” concluded the report authors.


Wood DA, Mahmud E, Thourani VH, et al. Safe reintroduction of cardiovascular services during the COVID-19 pandemic: Guidance from North American Society Leadership. Ann Thorac Surg. 2020. doi:10.1016/j.athoracsur.2020.04.017